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Enhanced recovery after surgery (ERAS) pathways in breast reconstruction: systematic review and meta-analysis of the literature

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Abstract

Purpose

Enhanced recovery after surgery (ERAS) pathways are increasingly promoted in post-mastectomy reconstruction, with several articles reporting their benefits and safety. This meta-analysis appraises the evidence for ERAS pathways in breast reconstruction.

Methods

A systematic search of Medline, EMBASE, and Cochrane databases was performed to identify reports of ERAS protocols in post-mastectomy breast reconstruction. Two reviewers screened studies using predetermined inclusion criteria. Studies evaluated at least one of the following end-points of interest: length of stay (LOS), opioid use, or major complications. Risk of bias was assessed for each study. Meta-analysis was performed via a mixed-effects model to compare outcomes for ERAS versus traditional standard of care. Surgical techniques were assessed through subgroup analysis.

Results

A total of 260 articles were identified; 9 (3.46%) met inclusion criteria with a total of 1191 patients. Most studies had “fair” methodological quality and incomplete implementation of ERAS society recommendations was noted. Autologous flaps comprised the majority of cases. In autologous breast reconstruction, ERAS significantly reduces opioid use [Mean difference (MD) = − 183.96, 95% CI − 340.27 to 27.64, p = 0.02) and LOS (MD) = − 1.58, 95% CI − 1.99 to 1.18, p < 0.00001] versus traditional care. There is no significant difference in the incidence of complications (major complications, readmission, hematoma, and infection).

Conclusion

ERAS pathways significantly reduce opioid use and length of hospital stay following autologous breast reconstruction without increasing complication rates. This is salient given the current US healthcare climate of rising expenditures and an opioid crisis.

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Authors and Affiliations

  1. Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Anaeze C. Offodile II, Stefanos Boukovalas, Rene D. Largo & Charles Butler

  2. University of Texas McGovern Medical School, Houston, TX, USA

    Cindy Gu

  3. Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada

    Christopher J. Coroneos

  4. Division of Plastic Surgery, Tufts Medical Center, Boston, MA, USA

    Abhishek Chatterjee

  5. Division of Plastic Surgery, University of Texas Medical Branch- Galveston, Galveston, USA

    Stefanos Boukovalas

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  1. Anaeze C. Offodile II
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  2. Cindy Gu
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Correspondence to Charles Butler.

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Offodile, A.C., Gu, C., Boukovalas, S. et al. Enhanced recovery after surgery (ERAS) pathways in breast reconstruction: systematic review and meta-analysis of the literature. Breast Cancer Res Treat 173, 65–77 (2019). https://doi.org/10.1007/s10549-018-4991-8

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